March
11, 2019 6:30 AM
It’s a mess from which the country’s health-care system would
never recover.
Obamacare failed. There is no denying
it anymore. The supposed “signature achievement” of the 44th president isn’t
just opposed by Republicans. The Affordable Care Act has now been jilted also
by many Democrats, who, like so modern-day Lotharios, have abandoned their
once-burning ardor for state insurance exchanges to pursue “single-payer”
health care.
Some readers are
yelling, “That was the plan all along!” Yes, but the stew is not fully cooked.
I doubt President Obama and the Pelosi Congress of 2009 and 2010 planned for
their party to move so radically this soon. Oh well. With burning hatred for
everything Trump as the accelerant — and with polling popularity of Bernie
Sanders’s “Medicare-for-all” legislation of last year serving as a
justification — much of the Democratic party now unapologetically embraces
outright socialized medicine.
The newly filed
120-page “Medicare for All Act of 2019,”
authored by Pramila Jayapal (D, Wash.), already has 106 co-sponsors — nearly
half of the Democratic caucus — and it seeks to yank America hard toward the
port side of the political spectrum. The bill — which resembles Medicaid more
than it does Medicare — would transform our entire health-care system into an
iron-fisted centralized technocracy, with government bureaucrats and
bioethicists controlling virtually every aspect of American health care from
the delivery of medical treatment, to the payment of doctors, to even, perhaps,
the building of hospitals. It would obliterate the health-insurance industry
and legalize government seizure of pharmaceutical manufacturers’ patents if
they refuse to yield to government drug-price controls.
Here are some of
the plan’s most destructive features:
It Would Drown the Country in Red Ink: True to its
title, the bill promises comprehensive and encompassing “free” health care for
everyone, including primary care, hospital and outpatient services, dental
coverage, vision, audiology, women’s reproductive health services, long-term
care, prescription drugs, mental-health and substance-abuse treatment,
laboratory and diagnostic services, ambulatory services, the list goes on and
on. Last year’s version of the plan authored by Bernie Sanders (I., Vt.) —
which didn’t include coverage for dental and long-term care — was estimated to
add $32 trillion to the budget over ten years. It is also not
irrelevant that the current Medicare — which is far more limited — is scheduled
to go broke in 2028.
Yes, There Would be Rationing: The bill creates a Physician
Practice Review Board “to assure quality, cost effectiveness, and fair reimbursements
for physician-delivered items and services.” The term “cost-effectiveness” is
code for rationing, which the law acknowledges by prohibiting the use of
assessment methods of determining “any value or cost-effectiveness that
discriminate against people with disabilities.”
Private Payment for Covered Health Services Would Effectively Be
Banned: The bill requires that all covered medical services be
provided without any out-of-pocket cost to patients. The only fee to which a
doctor, hospital, or other service provider would be entitled would be that
paid by the government. Kiss the health-insurance industry goodbye.
Doctors and Hospitals Would Become Government Contractors: The state
would not, strictly speaking, employ doctors directly. But doctors would be
coerced into becoming government contractors by the requirement that they sign
a “participation agreement” to be eligible to receive payments from the
government. The participation agreement forces medical professionals and
institutions to:
·
Accept the government fee as payment in full.
·
Allow the government to inspect their books for a variety of
purposes and bury themselves in administrative duties, such as filing periodic
reports.
·
Accept other provisions regulators may impose later — which, as
we saw with Obamacare, could be onerous and intrusive and aimed as much at
effecting social change as providing access to medical treatment.
Doctors who object
to the provisions of a participation agreement would have little choice if they
wanted to continue their careers, since they could be compensated for services
only if they were deemed “qualified providers,” a status restricted to those
who sign the agreement. (This is known in law as a “contract of adhesion,”
meaning providers have no bargaining power or ability to negotiate terms.) If
an individual provider’s agreement were revoked, he or she would be ineligible
to be hired by a hospital or medical group, because their participation
agreements require that they not employ any provider whose participation plan
was “terminated for cause.”
Private-Pay Health Care Would Be Destroyed: What about
doctors who wish to operate concierge practices, that is, accept cash directly
from patients? Outside of the few non-covered fields such as cosmetic surgery,
good luck! The doctor cannot have signed a participation agreement, since
qualified providers “may not bill or enter into any private contract with any
individual eligible for benefits under the Act for any item or service that is
a benefit under this Act.” That means the doctor’s entire practice would have to
be made up of people who opted not to be covered by the government, a very
small pool of patients — the few very wealthy who could afford to foot their
entire medical expenses out of their own pockets, and I suppose, “medical
tourists” who travel to the U.S. for the purpose of obtaining treatment.
The Bill Seeks to Remove Profit in the Health-Care Sector: True to its
socialist roots, the legislation would eliminate profit in health care. Indeed,
the bill states quite explicitly:
It is the sense of
Congress that tens of millions of people in the United States do not receive
healthcare services while billions of dollars that could be spent on providing
health care are diverted to profit. There is a moral imperative to correct the
massive deficiencies in our current health system and to eliminate profit from
the provision of health care.
To enforce the
“sense of Congress,” the bill forbids bureaucrats who determine the medical
fees that will be paid to providers — which includes institutions as well as
doctors and group practices — from taking into account the costs of “marketing”
the “profit or net revenue of the provider, or increasing the profit or net
revenue of the provider” or “incentive payments, bonuses, or other compensation
based on patient utilization of items and services, or any financial measure
applied with respect to the provider.” You think doctors have trouble receiving
adequate compensation from Medicare and Medicaid now? Just you wait!
The Government Could Steal Pharmaceutical Patents: The bill
requires the government to negotiate the price of medicines with drug companies.
The bargaining power in that negotiation would — as with participation
agreements — be all with the government. If a company refused to agree to the
government’s price, the bill states, “The Secretary shall authorize the use of
any patent,” by another company “for purposes of manufacturing such drug for
sale under Medicare for All Program,” with compensation paid to the
patent-owning company in an amount determined by the bureaucracy. How willing
would pharmaceutical executives be to green-light the billions in investments
required to develop new medicines knowing that the government could simply
seize their patent and license another company to manufacture the drugs if they
refused to sell it at a price the government demands?
Illegal Aliens Would Receive Free Health Care. Eligibility
to receive benefits is not limited to citizens and aliens here legally. Rather,
the bill reads: “Every individual who is a resident of the United States is entitled
to benefits for health care services under this Act.” Illegal aliens living
here are residents. Talk about a migration magnet. The only limitation on
coverage for aliens is a provision that forbids eligibility to anyone traveling
here “for the sole purpose of obtaining health care items and services provided
under the program.” That’s much less than meets the eye. If an illegal alien
traveled here to work, to escape violence, or to be with family, the exclusion
clause would not apply. Further demonstrating the intent to cover those here illegally,
enrollment in the program would be automatic “at the time of birth in the
United States (or upon establishment of residence in the United States).”
Residency could conceivably be established by a state driver’s license — now
widely allowed illegal aliens — or even a utility bill. And get this: Unlike
today’s Medicare identifier, the new Medicare Card would specifically not include a Social Security
number, which many illegal aliens don’t possess.
Women Would Receive Free Abortion: Currently,
the “Hyde Amendment” prohibits federal funding of abortion. That rare bit of
culture-wars comity would be destroyed by the bill, which provides: “Any other
provision of law in effect on the date of enactment of this Act restricting the
use of Federal funds [i.e., Hyde] for any reproductive health service shall not
apply to monies in the Trust Fund [the government entity that would be
established to pay health-care costs].”
The Medicare for
All Act of 2019 won’t become law while there is a Republican Senate and
president. But the 107 co-sponsors in the House have put the country on notice.
If the Democrats take over the government in 2021 as they — and some Never
Trump Republicans — hope, by 2022, the United States health-care system will
become a wholly controlled subsidiary of the United States government, bereft
of liberty, increasingly sclerotic, managed by unelected bureaucrats churning
out thousands of pages of onerous regulations, a centralized authoritarian mess
from which the country’s health-care system would never recover.
WESLEY J. SMITH — Wesley J.
Smith is an author and a senior fellow at the Discovery Institute’s Center on
Human Exceptionalism. @forcedexit
https://www.nationalreview.com/2019/03/medicare-for-all-plan-authoritarian/
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